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A Mutation in the 5' Non-High Mobility Group Box Region of the SRY Gene in Patients with Turner Syndrome and Y Mosaicism¹

Research Unit in Developmental Biology, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (P.C., E.d.l.C., J.P.M.); Department of Biologic Systems, Ciencias Biologicas y de la Salud, Universidad Autónoma Metropolitana-Xochimilco (M.L.); Department of Genetics, Hospital General de México, Secretaria de Salud, Facultad de Medicina, Universidad Nacional Autonoma de Mexico (A.C., S.K.-A.); and Departments of Reproductive Biology (B.C., F.V., A.U.-A.) and Pathology (E.R.), Instituto Nacional de la Nutrición Salvador Zubirán, Mexico D.F., Mexico

Address all correspondence and requests for reprints to: Dr. Juan Pablo Méndez, Unidad de Investigación Médica en Biología del Desarrollo, Coordinación de Investigación Médica, Avenida Cuauhtémoc 330, Apartado Postal 73–032, Colonia Doctores, C.P. 06725, México D.F., Mexico. E-mail: jpmb{at}servidor.unam.mx

In Ullrich-Turner syndrome (UTS) patients, the presence of a Y-chromosome or Y-derived material has been documented in frequencies ranging from 4–61%. Mutations of SRY (testis-determining gene) constitute the cause of XY sex reversal in approximately 10–15% of females with pure gonadal dysgenesis. Most of these mutations have been described in the HMG (high mobility group) box of the gene, which is the region responsible for DNA binding and bending; however, various mutations outside the HMG box have been reported. We carried out molecular studies of the SRY gene in three patients with a UTS phenotype and bilateral streaks; two presented a 45,X/46,XY mosaic, and the third a Y marker chromosome.

In two patients a missense mutation, S18N, was identified in the 5'non-HMG box region in DNA from blood and both streaks; this mutation was not identified in 75 normal males. Sequencing of the DNA region of interest was normal in the father and older brother of patient 1, demonstrating that in this patient the mutation was de novo.

A previous report of a 46,XY patient with partial gonadal dysgenesis who presented the same mutation as our patients indicates the probable existence of a hot spot in this region of the SRY gene and strengthens the possibility that all gonadal dysgeneses constitute part of a spectrum of the same disorder. It also demonstrates that a single genetic abnormality can result in a wide range of phenotypic expression.

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